Individual provider Active NPI

Gantuya Tserenpil, MD, MBA, MHA

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1225612591
Registry record updated May 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
125077320 Issued in IL
Practice address
4646 N Marine Dr
Chicago, IL 60640-5759
Phone
(773) 564-5225
Fax
(773) 564-5226
NPI assigned
May 11, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 30, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 125077320 IL Primary

Addresses

Primary practice location

4646 N Marine Dr
Chicago, IL 60640-5759

Mailing address

4646 N Marine Dr
Chicago, IL 60640-5759
Phone (773) 564-5225

Other practice location 1

4535 N Saint Louis Ave Fl 1
Chicago, IL 60625-5419
Phone (773) 387-4614

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241031003870 TX Practitioner - Internal Medicine 4789088972 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lufkin Physician Services PAGroup PAC ID 1153542998, 21 clinicians

Practice addresses (Care Compare)

505 S John Redditt Dr
Lufkin, TX 75904-3120
Phone (936) 634-8311

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Business Administration, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Lufkin Physician Services PA CurrentSince Sep 20, 2024 Accepting new patients
Piney Woods Healthcare System, L.P. Past Accepting new patients

Locations

200 Corporate Blvd
Lafayette, LA 70508

505 S John Redditt Dr
Lufkin, TX 75904
Phone (713) 512-1200

Interoperability endpoints

  • Direct secure messaging: gantuya.tserenpil.1@18552.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622332800000",
    "number": "1225612591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-564-5225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-564-5225",
            "fax_number": "773-564-5226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4535 N Saint Louis Ave Fl 1",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606255419",
            "country_code": "US",
            "telephone_number": "773-387-4614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TSERENPIL",
        "first_name": "GANTUYA",
        "name_prefix": "Dr.",
        "credential": "MD, MBA, MHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-11",
        "last_updated": "2021-05-30",
        "certification_date": "2021-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125077320",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.